Abaddon costs three Soul Hearts and grants six Black Hearts, damage up, fear shot, and no negative effects to ???. Abaddon can be bought safely regardless of current health, because its price can be deducted from the acquired Black Hearts retroactively.

Lazarus' Rags causes ??? to be resurrected as Lazarus Risen when he dies, allowing the gathering of Heart Containers. Once this happens, however, you are no longer playing as ???, and therefore cannot get any of his achievements/unlocks. The same effect happens with the use of Judas' Shadow.

Cursed Skull will automatically teleport ??? out of the room upon taking any damage, as he doesn't have any Red Hearts.

Dead Cat will remove all but one Soul Hearts. However, it can be used as a last resort if you are running very low on Soul Hearts.

Glass Cannon will bring ??? down to half a soul heart, and not give back any health upon leaving a room due to ???'s lack of red hearts. This item essentially takes away most of the player's health in exchange for a single high damage tear.

Guppy's Paw, since requiring red hearts to convert, would be a useless item to hold (but should still be picked up and swapped back in order to get credit towards the Guppy transformation).

Enemies who deal full hearts of damage can be very dangerous in the early floors of the game.

The Poop - While not the most useful item, it can allow ??? to cross small gaps by bombing the poop from the opposite side, much like one would for Rocks. Furthermore, in rooms with non-flying enemies that chase the player (with the exception of spiders), the poop can be used in a corner of the room making ??? untouchable, allowing the player to kill them without taking damage (if the player moves away from the pile of poop generated, this will no longer work).

The name "Blue Baby" had not appeared in the game itself until the Afterbirth expansion, with a co-op baby named as such.

???'s common nickname, Blue Baby, is a reference to blue baby syndrome, in which a baby's skin complexion appears blue from a lack of oxygen in its blood due to a congenital heart defect.

Many of Edmund's older flash games from Newgrounds feature ??? and Brother Bobby. ??? was Edmund's mascot from 1996-2002.

In several cutscenes, Isaac is depicted suffocating inside a chest. ??? first appears inside an identical chest, and is the follow up boss after Isaac. Blue skin tone is typically used to show suffocation, and X eyes imply that the character is either knocked out or deceased.

After death, the bowels of the deceased will loosen, causing them to defecate themselves. This is most likely the reason ??? starts with The Poop.

Unlike many of the other characters, ??? does not appear in the Bible or any religious scripture.

The Ankh will resurrect any character as ???, even before he is unlocked.

Although "Blue Baby" is considered an unofficial nickname for ???, the character is referred to by this name in the some of the game's code. One example of this is the image file for the character, named 'character_006_bluebaby'

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